Shame: Secret Ally of Illness (cont.)

When we feel bad about having failed or about having done something we think is wrong, we feel guilt or shame.

"Guilty people feel bad about their behavior. Shamed people feel bad about themselves," Tangney tells WebMD. "Guilt is a less overwhelming feeling. It is less self-esteem related, and doesn't affect our sense of who we are."

Guilt motivates a person to repair the damage done by bad behavior and to make positive changes in their lives. Shame works in the other direction. It makes us want to disappear.

"When people are ashamed, the defense mechanism is hiding," Joseph says. "We become like little kids who are ashamed and hide their faces in their mothers' aprons. It is hard to get past that."

As adults, we don't have our mothers' skirts to hide behind. But our reaction to shame often isn't any more mature.

"When people feel ashamed they are more likely to hide, deny, escape, and externalize blame," Tangney says. "When people feel guilt they are motivated to face the music. When people feel shame they want to duck the heat."

Tangney lists five ways shame can be destructive:

  • Lack of motivation to seek care.
  • Lack of empathy. Shame, Tangney says, is very self-involved. People feeling shame cut themselves off from other people.
  • Anger and aggression. Tangney says shame has a special link to anger. "In day-to-day life, when people are shamed and angry they tend to be motivated to get back at a person and get revenge," she says.
  • Psychological problems. Tangney says shame is associated with eating disorders, substance abuse, anxiety, depression, and other mental disorders.
  • Problematic moral behavior. Tangney's team tested fifth-grade students, and followed them until they were 18 years old. Shame-prone kids were prone to substance abuse, earlier sexual activity, less safe sexual activity, and involvement with the criminal justice system.

Because we tend to feel more shame about our bodies than about other aspects of ourselves, health issues are particularly likely to evoke shame. And no health issues evoke shame more than those involving sex, says Ilan Meyer, PhD, associate professor of clinical sociomedical sciences at Columbia University's Mailman School of Public Health.

"If people are embarrassed to talk about their sexuality, they are not going to be seeking out services, testing or counseling on the topic," Meyer tells WebMD. "People often don't seek treatment for an STD [sexually transmitted disease]. Or when they do, they lie or pretend it is something else. I know of someone with an STD who called the doctor and said he had a cold, and wanted antibiotics. Of course this would be the wrong drug for both conditions, but this is a case of a person acting out of shame, trying to manipulate the situation to get care."

In the Bible, God often punishes people by making them ill -- often with humiliating diseases.

"That is very much lodged in people's minds," Friedman says. "When something goes wrong with our health we think, 'What did I do to deserve this?' People feel -- and this may be an unconscious feeling -- that if something befalls them, they somehow did wrong."

It's a pernicious feeling. If we feel bad because we are sick, we can be treated for the sickness and feel better. But if we feel sick because we are bad, we are powerless.

Religion isn't the problem here. If we feel that our fate is in God's hands, we aren't afraid to seek treatment. We become powerless only when we believe our illness stems from a moral flaw that we must hide from everyone, including God.

What do you regard as most humane? To spare someone shame. -- Friedrich Nietzsche, German philosopher

One of the oldest stories of healing shame is in the Old Testament, Friedman notes. God punishes Miriam by giving her leprosy. He answers Moses' prayer that she be healed, but insists that she must be shamed by being expelled from the Israelites' camp for seven days.

Even though they are in dire circumstances -- they are escaping Egypt for the Promised Land -- the Israelites do not move from camp until Miriam has served her sentence. Then they welcome her back from her shame.

"Miriam had to be marginalized so that her shame could be recognized. But then the whole camp waits for her to welcome her back from her shame," Friedman says. "But if you are marginalized, who is inviting you to dinner? If you are someone who has fallen through the cracks, who is thinking of you? A fact of modern cultural life is that there is a decreased attention to integrating marginal people into some kinds of communities."

One relatively recent positive change is that more and more celebrities are speaking out about their own shame-associated conditions.

"When celebrities come out with their stories -- like Brooke Shields talking about her postpartum depression -- that is a very big thing," Tangney says.

But often, simple human contact is the most important thing for a shamed person. Even this can be difficult to offer because shame makes people withdraw.

"The most important thing is to keep up contact with someone -- for example, the kid who drops out of college and is now a strung-out marijuana addict," Tangney says. "Marginalized people -- and nobody is more marginalized than the mentally ill -- need to have a place in society. That is a very powerful message that should be attended to by communities, whether they are religious or family or neighborhood communities."

Approaching a shamed person can be tricky, Josephs warns.

"If you see shame preventing someone from getting health care, you can confront it as irrational," he says. "You can say there is nothing to be ashamed of, and if people hear it, they hear it. But when you point out that they are ashamed, people can get touchy and angry. If you point out their shame, you could get into a fight. So bring it up, but in a tactful way, knowing this is a tough issue."

Tangney says that the best approach is to avoid further shaming. The first thing to offer is support and empathy. Rather than confront a person's shame, it's better to point out -- very, very gently -- how a person's behavior is harming areas of life that the person really values.